Fifteen year comparison of antipsychotic use in people with dementia within hospital and nursing home settings: sequential cross‐sectional study

Connelly, Peter; Law, Emma; Angus, Susan; Prentice, Neil

doi:10.1002/gps.2313

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…This confirms earlier research, which highlighted that anti-psychotic use for people with dementia in nursing homes was becoming increasingly prevalent [31]. Therefore, to achieve maximum benefit, and in line with the NDS, and the approach adopted in this project, baseline data should be used to target where the intervention is delivered [14].…”

Section: Discussionsupporting

confidence: 82%

“…The project was solely conducted within a single PCT, and whilst the PCT covered a very mixed area, the results are not necessarily generalisable to other locations. People initiated on anti-psychotics by secondary care were excluded and a joint pharmacist and GP review, linking with secondary care including experts in the non-pharmacological management of BPSD, might have a more significant impact in limiting the inappropriate prescribing of anti-psychotics [31]. …”

Section: Discussionmentioning

confidence: 99%

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A pharmacy led program to review anti-psychotic prescribing for people with dementia

Child¹,

Clarke²,

Fox

et al. 2012

BMC Psychiatry

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BackgroundAnti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics.MethodsThis project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search.ResultsData were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p < 0.0001; Fisher’s exact test). In 26 practices there was no-one on the dementia register receiving low-dose anti-psychotics.Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review.ConclusionsIn total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

A pharmacy led program to review anti-psychotic prescribing for people with dementia

Child¹,

Clarke²,

Fox

et al. 2012

BMC Psychiatry

View full text Add to dashboard Cite

show abstract

“…This review highlighted the paucity of information on current levels and patterns of prescribing, especially in different residential settings. Most available information is from studies of care homes alone, usually nursing homes or small local studies and currently available national data cannot distinguish prescribing in care homes and the community (Oborne et al, 2002;Alldred et al, 2007;Lindesay et al, 2003;Fahey et al, 2003;Mcgrath and Jackson, 1996;Connely et al, 2010). Such comparative information on prescribing in different settings is essential for practitioners to benchmark their own practice and to estimate the resource and workload implications of a strategy to reduce inappropriate prescribing.…”

Section: Introductionmentioning

confidence: 97%

Antipsychotic prescribing to older people living in care homes and the community in England and Wales

Shah

Carey

Harris

et al. 2010

Int. J. Geriat. Psychiatry

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Despite safety concerns, antipsychotic prescribing is markedly higher in care homes than in the community, and strongly associated with dementia in both settings. In England and Wales, we estimate that 54 000 older care home patients and 50 000 community patients receive antipsychotic medication without a diagnosis of severe mental illness with important implications for health and social services.

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“…Although there was a significant expansion in psychiatric service provision in the late 1990s and earlier this decade in association with the introduction of cholinesterase inhibitors, the cost was often a reduction in services provided to care homes. As elsewhere this may contribute to the excessive use of antipsychotic medication with one study (Connelly et al, 2010) showing an increase in their use over the last 15 years, particularly for the treatment of verbal aggression. Informal carers are seldom involved in the day-to-day management of a care home resident with the caring role being handed over to formal staff.…”

Section: Care Homesmentioning

confidence: 93%

Scottish dementia strategy editorial

Connelly

2010

Int J Geriat Psychiatry

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Fifteen year comparison of antipsychotic use in people with dementia within hospital and nursing home settings: sequential cross‐sectional study

Abstract: Compared to a long-stay hospital setting, antipsychotic drug use for people with dementia in nursing homes has risen and become less systematic. This cannot be explained by increasing core behaviour symptoms or differences in physical dependency.

Cited by 8 publications

References 15 publications

A pharmacy led program to review anti-psychotic prescribing for people with dementia

A pharmacy led program to review anti-psychotic prescribing for people with dementia

Antipsychotic prescribing to older people living in care homes and the community in England and Wales

Scottish dementia strategy editorial

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